title: Interleukin 17, interleukin 22 and FoxP3 expression in tissue and serum of non-segmental vitiligo: a case- controlled study on eighty-four patients.
abstract: BACKGROUND
  Skewing of responses towards T helper (Th) 17 and away from T regulatory cells (T-regs) has been suggested to be partially involved in autoimmune diseases like vitiligo.
  
  
  OBJECTIVE
  Clarify the possible role and relationship between Th17 and T-regs in vitiligo by measuring tissue, systemic levels of interleukin (IL)-17, IL-22 and Forkhead box P3.
  
  
  METHODS
  84 non-segmental vitiligo patients and 80 controls were included. Vitiligo Area Scoring Index, Vitiligo Disease Activity and stress score were determined. Skin biopsies underwent immunohistochemical staining for IL-17, IL-22 and FoxP3 and their systemic levels were determined by ELISA and quantitative real time PCR.
  
  
  RESULTS
  Mean area % of +ve immunostaining and serum levels of IL-17 (34.12 ± 5.12, 23.62 ± 8.17 pg/mL) and IL-22 (48.63 ± 19.23, 43.53 ± 11.95 pg/mL) were significantly higher in patients compared to controls (15.33 ± 4.19, 12.83 ± 3.29 pg/mL) (13.44 ± 3.82, 9.92 ± 4.7 pg/mL) (P<0.001). Mean area % of +ve immunostaining and peripheral blood levels of FoxP3 were significantly lower in patients (2.67 ± 0.54, 0.574 ± 0.32) compared to controls (7.12 ± 0.18, 1.48 ± 0.49) (P<0.001). In patients, a positive correlation between IL-17 and IL-22 was detected (r = 0.671, P<0.001), each showing negative correlation with FoxP3 (r = -0.548, P<0.001), (r = -0.382, P<0.001). VASI, VIDA and stress score correlated positively with IL-17, IL-22 and negatively with FoxP3.
  
  
  CONCLUSIONS
  Th17 and T-regs are intertwined in the complexity of vitiligo giving hope of treatment through adjuvant therapies controlling the delicate balance between them.
authors.affiliation: Department of Dermatology.
authors.forename: Mostafa Abou
authors.initials: MA
authors.lastname: Elela
authors.affiliation: Department of Dermatology.
authors.forename: Rehab A
authors.initials: RA
authors.lastname: Hegazy
authors.affiliation: Department of Dermatology.
authors.forename: Marwa Mohamed
authors.initials: MM
authors.lastname: Fawzy
authors.affiliation: Department of Biochemistry, Kasr Al Aini Hospital, Cairo University, 511 Al Ahram Street/Giza Square 12211 Cairo, Egypt.
authors.forename: Lalia A
authors.initials: LA
authors.lastname: Rashed
authors.affiliation: Department of Dermatology.
authors.forename: Hoda
authors.initials: H
authors.lastname: Rasheed
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D051858:Forkhead Transcription Factors / Q000032:analysis / Q000096:biosynthesis*; D006801:Humans; D020381:Interleukin-17 / Q000032:analysis / Q000096:biosynthesis*; D007378:Interleukins / Q000032:analysis / Q000096:biosynthesis*; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000737:chemistry; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*; D058504:Th17 Cells / Q000276:immunology*; D014820:Vitiligo / Q000097:blood / Q000276:immunology* / Q000378:metabolism*; D055815:Young Adult; D000097043:Interleukin-22
chemical_list: D051858:Forkhead Transcription Factors; D020381:Interleukin-17; D007378:Interleukins; D000097043:Interleukin-22; C418974:FOXP3 protein, human
keywords: FoxP3; IL-17; IL-22; T-regs; Th-17; vitiligo